GC# Program Development Grant to Prepare Students with Disabilities to Exit School with Work Readiness Skills

Transcription

1 ANNOUNCEMENT OF FUNDING OPPORTUNITY GC# Program Development Grant to Prepare Students with Disabilities to Exit School with Work Readiness Skills Legislative Authority Section 614 (20 USC 1414) IDEA Amendments, 2004 Purpose/Goal The Program Development Grant program is a competitive grant program to provide funding for schools to enhance their instructional programs to increase students with disabilities access to and participation in career and technical education (CTE) coursework, instruction in the Career Development and Occupational Studies (CDOS) learning standards, and work-based learning opportunities to fulfill requirements for the award of the NYS CDOS Commencement Credential. Eligible Applicants New York State school districts, approved private schools, Special Act School Districts, (see link below), State supported schools and boards of cooperative educational services (BOCES) are eligible to apply. Eligible applicants may apply individually or form a consortium with one or more eligible applicants. For more information on the approved private schools: Funding No eligible applicant may individually apply for, lead or be a member of an applicant consortium, for more than one grant application. Source: IDEA Discretionary Funds under Part B Estimated funds available: $10 Million annually, subject to the appropriations and availability of funds. Application Due Date and Mailing Address Anticipated Project Period: 9/1/15 to 6/30/18 Maximum Annual Award Amounts: New York City: $500,000 Syracuse, Rochester, Buffalo, Yonkers school districts: $400,000 Rest of State: $300,000 A consortium of eligible applicants: $300,000. Submit 1 original and 3 copies of the application and an electronic copy (Word or pdf) of the application on CD ROM postmarked by May 29, 2015 New York State Education Department Attn: Program Development Grant Grants Management 89 Washington Avenue Room 464 EBA Albany, NY Questions and Answers Questions and Answers: Questions about this RFP must be sent to [email protected] no later than April 15, All questions and answers will be posted by April 22, 2015, to the following website: 1

2 Non-Mandatory Notice of Intent SED Contacts The Notice of Intent (NOI) is not a requirement for submitting a complete application by the application date; however, NYSED strongly encourages all prospective applicants to submit an NOI to ensure a timely and thorough review and rating process. A non-profit applicant s NOI will also help to facilitate timely review of their prequalification materials. The notice of intent is a simple notice stating your organization s (use the legal name) intent to submit an application for this grant. The due date is April 28, Please send the NOI to [email protected]. Name: Program Matters: Sophie McDermott, [email protected] Fiscal Matters: Katherine Goodrich [email protected] M/WBE Matters: Joan Ramsey [email protected] The New York State Education Department (NYSED) does not discriminate on the basis of age, color, religion, creed, disability, marital status, veteran status, national origin, race, gender, genetic predisposition or carrier status, or sexual orientation in its educational programs, services and activities. Portions of any publication designed for distribution can be made available in a variety of formats, including Braille, large print or audiotape, upon request. Inquiries regarding this policy of nondiscrimination should be directed to the Department s Office for Diversity, Ethics, and Access, Room 530, Education Building, Albany, NY Program Purpose and Overview: Application Guidance NYSED is soliciting grant applications to provide funding for schools to enhance their instructional programs to increase students with disabilities access to and participation in Career and Technical Education (CTE) coursework, instruction in the Career Development and Occupational Studies (CDOS) learning standards, and work-based learning opportunities. The purpose of these grants are to develop increased opportunities for all students with disabilities to exit school with the knowledge and skills to minimally be ready for entry level employment and to minimally meet the requirements for the award of the NYS CDOS Commencement Credential. Beginning with the school year and thereafter, students with disabilities may earn a NYS CDOS Commencement Credential. This credential is awarded by the school district in recognition of an individual student s preparation and skills for postschool employment. To be awarded the CDOS Commencement Credential, a student must: develop a commencement level Career Plan that includes documentation of the student s self-identified career interests; career-related strengths and needs; career goals; and career and technical education (CTE) coursework and work-based learning experiences that the student plans to engage in to achieve those goals; 2

3 demonstrate achievement of the commencement level CDOS learning standards in the areas of career exploration and development; integrated learning; and universal foundation skills; successfully complete at least 216 hours of CTE coursework and/or work-based learning experiences (of which at least 54 hours must be in work-based learning experiences); have at least one completed employability profile that documents the student s employability skills and experiences; attainment of each of the commencement level CDOS learning standards; and, as appropriate, attainment of technical knowledge and work-related skills, work experiences, performance on industry-based assessments and other work-related and academic achievements. In lieu of a student meeting the above requirements to be awarded the NYS CDOS Commencement Credential, a student may be awarded this credential if the student has met the requirements for one of the nationally recognized work readiness credentials, including but not limited to: National Work Readiness Credential; SkillsUSA Work Force Ready Employability Assessment; National Career Readiness Certificate WorkKeys - (ACT); and Comprehensive Adult Student Assessment Systems Workforce Skills Certification System. For more information on these nationally recognized work readiness credentials, please see Additional information on the instructional preparation school districts must provide to students for the award of the CDOS Commencement Credential can be found at Grant funds may be used to enhance a school s instructional programs toward the CDOS learning standards, to develop and/or expand CTE coursework that is accessible and meaningful to students with disabilities and to develop and/or expand appropriate work-based learning activities. Applicants must identify the goals to be achieved through this grant award and the specific activities to address one or more of the following outcome areas: Effective transition planning and student-driven career planning that incrementally prepare students for successful integrated post-school employment. Effective instruction to prepare students to meet the CDOS learning standards at the commencement level in the areas of Career Development, Integrated Learning and Universal Foundation Skills. 3

4 Increased availability and/or development of CTE coursework including integrated or specialized courses in which students with disabilities will have a meaningful opportunity to participate and progress. Increased opportunities for students to engage in appropriate work-based learning opportunities which reflect and incorporate students transition and career plans. Project Funding Estimated funds available: $10 Million annually depending on the appropriation and availability of funds. Maximum Annual Award Amounts: New York City: $500,000 Syracuse, Rochester, Buffalo, Yonkers school districts: $400,000 Rest of State: $300,000 A consortium of eligible applicants: $300,000. Year 2 and Year 3 budget amounts for each applicant may not exceed that applicants Year 1 budget. Project Period Anticipated Project Period: 9/1/15 to 6/30/18 New Prequalification Requirement The State of New York has implemented a new statewide prequalification process (described in designed to facilitate prompt contracting for not-for-profit vendors. All not-for-profit vendors are required to prequalify prior to grant application. This includes all currently funded not-for-profit institutions that have already received an award and are in the middle of the program cycle. The pre-qualification must be completed by all not-for-profit institutions prior to application in order to receive an award under this RFP. Please review the additional information regarding this requirement in the Prequalification for Individual Applications section below. Eligible Applicants: NYS public school districts, approved private schools, Special Act School Districts, State supported schools or Boards of Cooperative Educational Services (BOCES) may apply. Eligible applicants may apply individually or form a consortium with one or more eligible applicants, provided that one Eligible Applicant serves as the lead applicant/fiscal agent for the grant, and cannot act solely as a flow-through for grant funds to pass to other recipients. The fiscal agent must provide a minimum of 20% of the direct services 4

5 supported by this grant, as reflected in the budget (please see NYSED Consortium Policy for State and Federal Discretionary Grant Programs for additional information). No eligible bidder may individually apply for, lead or be a member of an applicant consortium, for more than one grant application. Allowable Expenses: Salaries and benefits of staff to develop appropriate additional CTE coursework and/or work-based learning experiences appropriate for students with disabilities Subcontracting for professional development and/or consultation related to workbased learning, job coach training, development of CTE integrated or specialized coursework and/or enhanced instruction and documentation of student achievement of the CDOS learning standards Substitute costs for staff to participate in professional development and/or collaborative activities o Indirect costs o School districts and BOCES must use the restricted indirect cost rates calculated by the State Education Department. o Not-for profit organizations must prepare their budgets using an indirect cost rate of up to 2.6 percent. If awarded funding, they may apply for a higher indirect cost rate of up to 8 percent, by completing and submitting an FS-87-R Form to the Department. Note that approval for a higher indirect cost rate must be requested and approved each year. o For more information, visit the website Travel to attend professional development sessions relevant to the project/ The applicant should budget for travel expenses at the federal rates. No out of state travel is acceptable. Federal Mileage rates may be found at: Federal per diem rates may be found at: Applicants must describe how the resources of the project will supplement and not supplant other training and school improvement activities of the district. Nonallowable Expenses: Purchase of materials to be used in instruction with students (e.g., smartboards, curricula) Transportation of students and/or staff to and from community experiences Capital construction, renovations, and equipment costs Food or refreshment items Costs associated for students to take the tests associated with any of the nationally recognized work readiness credentials 5

6 Funds allocated for salaries for professional staff cannot be redirected for other purposes. Any items in the proposed budget deemed to be non-allowable or inappropriate will be eliminated. NYSED s Consortium Policy for Federal and State Discretionary Grant Programs As previously stated, applicants may form a consortium to apply for the grant. In order to do so, the consortium must meet the following requirements: 1. The consortium must designate one of the participants to serve as the applicant and fiscal agent for the grant. The applicant agency must be an eligible grant recipient. All other consortium members must be eligible grant participants, as defined by the program statute or regulation. 2. In the event a grant is awarded to a consortium, the grant or grant contract will be prepared in the name of the applicant agency/fiscal agent, not the consortium, since the group is not a legal entity. 3. The applicant agency/fiscal agent must meet the following requirements: a. Must be an eligible grant recipient as defined by statute; b. Must receive and administer the grant funds and submit the required reports to account for the use of grant funds; c. Must require consortium members to sign an agreement with the fiscal agent that specifically outlines all services each member agrees to provide. d. Must be an active member of the consortium. e. Cannot act solely as a flow-through for grant funds to pass to other recipients. NYSED may establish a minimum level of direct service to be provided by the fiscal agent. For purposes of this grant, NYSED has established a 20% minimum. f. Is PROHIBITED from subgranting funds to other recipients. The fiscal agent is permitted to contract for services with other consortium members or consultants to provide services that the fiscal agent cannot provide itself. g. Must be responsible for the performance of any services provided by the members, consultants, or other organizations and must coordinate how each plan to participate. Deliverables: 1. Develop new or expand existing career and technical education courses and/or work-based learning programs for students with disabilities and/or expand supports to students to engage in career planning and ensure appropriate development and implementation of transition programs and services for students with disabilities to develop their work readiness knowledge and skills. 2. Meet periodically with and compile reports on the participation and outcome of stakeholder consultation in improving the school s instructional and work-based learning programs leading to awards of the CDOS Commencement Credential. 3. Provide professional development and leadership actions to develop and sustain the changes to the school s work readiness instructional programs and activities. 6

7 4. Develop and implement a plan to enhance the school s infrastructure to provide increased opportunities for students with disabilities to exit school with the CDOS Commencement Credential. Reporting Grantees must submit an annual performance report at the end of each grant period but no later than the first Friday in October of each year of the grant. The performance report should demonstrate that substantial progress has been made toward meeting the project goals and the program performance indicators. Additional information about the annual performance report will be made available to grantees by SED after grant awards are made. Grantees that do not demonstrate adequate performance may be discontinued. Required Reports: Recipients must submit an annual performance report (due August 1) in a format specified by NYSED s P-12: Office of Special Education for each year of funding that demonstrates completion of project activities. The performance report must demonstrate the progress made toward meeting the project goals and the program performance indicators. Forms to be used for performance reports will be sent to the successful applicants at the time of the award notice. In year one, applicants must submit a four-month (due January 31, 2016) and end-ofyear project report that demonstrates successful completion of project activities and goals. Applicants must also submit quarterly vouchers and expenditure reports (due 10/31, 1/31, 4/30, 7/31). All reports must be submitted by the due date specified by NYSED. Failure to submit the required progress reports may result in the suspension of future payments. 7

8 The proposal narrative and budget narrative should not exceed twenty (20) pages. PROPOSAL NARRATIVE 1. Abstract (no points) Provide a summary describing the entire proposal. This summary should give the reader a succinct and concise overview of the applicant s proposal, its goals and objectives, and how funds will be used to maximize opportunities for students with disabilities to engage in meaningful career planning, career and technical coursework and work-based learning activities to ensure students are work-ready and are able to demonstrate competencies at the commencement level in the CDOS learning standards. 2. Need for Project (15 points) Explain the extent to which the applicant currently offers integrated and/or specialized CTE coursework and work-based learning experiences for students with disabilities (e.g., job shadowing, community service, service learning, school based enterprises and/or community based work programs); the extent to which students with disabilities participate in such programs; and how the grant funds will be critical to implementation of work-based learning and educational programs to support students with disabilities access and progress in the general education curriculum and the attainment of the CDOS Commencement Credential. 3. Project Design (25 points) Describe the goals, objectives and activities of the proposed project and include how the applicant will: Develop new or expand existing career and technical education courses and/or work-based learning programs for students with disabilities and/or expand supports to students to engage in career planning and ensure appropriate development and implementation of transition programs and services for students with disabilities to develop their work readiness knowledge and skills. Meet periodically with and compile reports on the participation and outcome of stakeholder consultation in improving the school s instructional and work-based learning programs leading to awards of the CDOS Commencement Credential. Provide professional development and leadership actions to develop and sustain the changes to the school s work readiness instructional programs and activities. Develop and implement a plan to enhance the school s infrastructure to provide increased opportunities for students with disabilities to exit school with the CDOS Commencement Credential. 8

9 In addition, the applicant must provide a plan for sustainability of the work of the project beyond the grant-funded years (including a plan for retention of new or dedicated staff that work on the project). 4. Work Plan (20 points) Utilizing the attached work plan format (Template A), identify the specific activities of the project as outlined in the Project Design and include appropriate measureable goals for each. Timelines for implementation and staff responsible to ensure completion of activities and achievement of goals must be clearly noted. 5. Project Evaluation (5 points) Describe how the applicant will evaluate effectiveness of the project. 6. Project Personnel (5 Points) Provide information regarding project personnel and their respective roles and responsibilities. Include qualifications of project personnel with regard to education, training and experience, and provide a justification as to how that staff person is qualified to implement the particular project activity to which they are assigned. 7. Organizational Capacity (10 Points) Describe the applicant s experience and/or current capacity to fulfill the commitments described in this grant proposal. Identify collaborations to be established including those with institutions of higher education, community-based organizations, adult service agencies, employers, and business organizations. BUDGET AND BUDGET NARRATIVE (20 POINTS): Applicants must submit: a detailed FS-10 budget with this application for the initial ten month period of September 1, 2015, through June 30, 2016; a three-year budget summary (Template B) for the entire grant period Year 2 and Year 3 budget amounts for each applicant may not exceed that applicants year 1 budget.; and an overall proposed expenditure plan in the form of a budget narrative that describes proposed expenditures over the 3-year period that are appropriate, reasonable and necessary to support the project activities and goals. Proposed expenditures over the 3-year period must clearly support project activities. The described expenditures and activities must be supplemental to and not supplant or duplicate services currently provided. 9

10 Budget (FS-10) and 3-Year Summary Budget Applicants must submit a FS-10 budget with this application, for the initial 10 month project period of September 1, June 30, Applicants must also submit a three year budget summary. The applicant must complete the FS-10 Budget Form. Budgeted costs must be in compliance with applicable State and federal laws and regulations and the Department s Fiscal Guidelines. These guidelines, as well as the FS-10 form, are available online at the following URL: The FS-10 must bear the original signature of the Chief School/Administrative Officer. Information about the categories of expenditures and general information on allowable costs, applicable cost principles and administrative regulations are available in the Fiscal Guidelines for Federal and State Aided Grants at The budget should be reasonable and appropriate to cover program expenses. For more information, visit the website Review and Rating of Applications: All complete proposals received by the deadline will be reviewed using the following criteria and ratings. Applicants must ensure that all components of this application request have been addressed, the required number of copies has been provided, all forms and assurances have been completed, and the original signatures are included as required. NYSED reserves the right to reject all proposals received or to cancel this request for proposal if it is in the best interests of NYSED. Method of Award Each eligible proposal will be reviewed by at least two reviewers. Each reviewer will score the proposal according to the indicated point criteria in the Proposal Narrative and the Budget using the Proposal Evaluation Rubric. If individual scores are more than 15 points apart, another reviewer will score the application. The two scores closest in numeric value will be averaged to calculate the final average score of the application. If the third reviewer s score is equal to the average of the two original scores, the third reviewer s score will become the final score. Budgets will be adjusted to eliminate any unallowable or inappropriate expenditure. 10

11 Proposals that receive a final average score of 60 or more will be considered for funding. Awards will be made to the highest ranking proposal in rank order of score based on availability of funds. In the event of tie scores, proposals with the highest score on in the Proposal Narrative will be ranked higher. PREQUALIFICATION FOR INDIVIDUAL APPLICATIONS Pursuant to the New York State Division of Budget Bulletin H-1032, dated June 7, 2013, New York State has instituted key reform initiatives to the grant contract process which require not-for-profits to register in the Grants Gateway and complete the Vendor Prequalification process in order for proposals to be evaluated. Information on these initiatives can be found on the Grants Reform Website ( Proposals received from not-for-profit applicants that have not Registered and are not Prequalified in the Grants Gateway on the proposal due date of 5:00 PM on May 29, 2015 cannot be evaluated. Such proposals will be disqualified from further consideration. Below is a summary of the steps that must be completed to meet registration and prequalification requirements. The Vendor Prequalification Manual ( on the Grants Reform Website details the requirements and an online tutorial ( are available to walk users through the process. 1) Register for the Grants Gateway. On the Grants Reform Website, download a copy of the Registration Form for Administrator ( fillable.pdf). A signed, notarized original form must be sent to the Division of Budget at the address provided in the instructions. You will be provided with a Username and Password allowing you to access the Grants Gateway. If you have previously registered and do not know your Username please [email protected]. If you do not know your Password please click the Forgot Password ( Mode=Forgot) link from the main log in page and follow the prompts. 2) Complete your Prequalification Application. Log in to the Grants Gateway If this is your first 11

12 time logging in, you will be prompted to change your password at the bottom of your Profile page. Enter a new password and click SAVE. Click the Organization(s) link at the top of the page and complete the required fields including selecting the State agency you have the most grants with. This page should be completed in its entirety before you SAVE. A Document Vault link will become available near the top of the page. Click this link to access the main Document Vault page. Answer the questions in the Required Forms and upload Required Documents. This constitutes your Prequalification Application. Optional Documents are not required unless specified in this Request for Proposal. Specific questions about the prequalification process should be referred to your agency representative at [email protected] or to the Grants Reform Team at [email protected]. 3) Submit Your Prequalification Application After completing your Prequalification Application, click the Submit Document Vault Link located below the Required Documents section to submit your Prequalification Application for State agency review. Once submitted the status of the Document Vault will change to In Review. If your Prequalification reviewer has questions or requests changes you will receive notification from the Gateway system. Once your Prequalification Application has been approved, you will receive a Gateway notification that you are now prequalified to do business with New York State. Vendors are strongly encouraged to begin the process as soon as possible in order to participate in this opportunity. Debriefing Procedures All unsuccessful applicants may request a debriefing within five (5) business days of receiving notice from NYSED. Bidders may request a debriefing letter on the selection process regarding this RFP by submitting a written request to the Fiscal Contact person at: NYS Education Department Contract Administration Unit 89 Washington Avenue Room 501W EB Albany, NY

13 The Fiscal Contact person will make arrangements with program staff to provide a written summary of the proposal s strengths and weaknesses, as well as recommendations for improvement. Within ten (10) business days, the program staff will issue a written debriefing letter to the bidder. Contract Award Protest Procedures Applicants who receive a notice of non-award may protest the NYSED award decision subject to the following: 1. The protest must be in writing and must contain specific factual and/or legal allegations setting forth the basis on which the protesting party challenges the contract award by NYSED. 2. The protest must be filed within ten (10) business days of receipt of a debriefing letter. The protest letter must be filed with: NYS Education Department Contract Administration Unit Attn: GC # Program Development Grant 89 Washington Avenue Room 501W EB Albany, NY The NYSED Contract Administration Unit (CAU) will convene a review team that will include at least one staff member from each of NYSED s Office of Counsel, CAU, and the Program Office. The review team will review and consider the merits of the protest and will decide whether the protest is approved or denied. Counsel s Office will provide the bidder with written notification of the review team s decision within seven (7) business days of the receipt of the protest. The original protest and decision will be filed with OSC when the contract procurement record is submitted for approval and CAU will advise OSC that a protest was filed. 4. The NYSED Contract Administration Unit (CAU) may summarily deny a protest that fails to contain specific factual or legal allegations, or where the protest only raises issues of law that have already been decided by the courts. Entities Responsibility Projects must operate under the jurisdiction of the local board of education, or other appropriate governing body, and are subject to at least the same degree of accountability as all other expenditures of the local agency. The local board of education, or other appropriate governing body, is responsible for the proper disbursement of, and accounting for project funds. Written agency policy concerning wages, mileage and travel allowances, overtime compensation, or fringe benefits, as 13

14 well as State rules pertaining to competitive bidding, safety regulations and inventory control must be followed. Supporting or source documents are required for all grant related transactions entered into the local agency s recordkeeping systems. Source documents that authorize the disbursement of grant funds consist of purchase orders, contracts, time and effort records, delivery receipts, vendor invoices, travel documentation and payment documents. Supporting documentation for grants and grant contracts must be kept for at least six years after the last payment was made unless otherwise specified by program requirements. Additionally, audit or litigation will freeze the clock for records retention purposes until the issue is resolved. All records and documentation must be available for inspection by State Education Department officials or its representatives. For additional information about grants, please refer to the Fiscal Guidelines for Federal and State Aided Grants, Safety and Health Requirements Both the applicant and any partnering organization operating in a school district must adhere to New York State s SAVE laws, including provisions related to fingerprinting of staff. Programs located in school buildings will be governed by the district s School Safety Plan and any related building-level plans. For all activities operated by outside entities that are linked with the Community Schools initiative that take place in a school building, all staff must be trained in and familiar with the School Emergency Response Plan and its emergency procedures. If the proposed program is school linked but located at a site other than the school building, the provisions for School-Age Child Care Registration detailed below for community organization applicants shall apply. If the applicant is a community organization, college or university, municipality or other eligible entity and proposes to serve only children ages 13 and older, it is recommended that the applicant work with its partnering school(s) to ensure the safety and health of all participants, including reasonable staff-to-student ratios and background clearances for staff. Registration in Federal System for Award Management (SAM) In order to be awarded federal funds, an agency must be registered (and then maintain a current registration) in the federal System for Award Management known as SAM ( SAM is a government-wide, web-enabled database that collects, validates, stores and disseminates business information about organizations receiving federal funds. Information on an agency s registration in SAM needs to be provided on the Payee Information Form that must be submitted with the application. 14

15 Payee Information Form/NYSED Substitute W-9 The Payee Information Form is a packet containing the Payee Information Form itself and an accompanying NYSED Substitute W-9. The NYSED Substitute W-9 may or may not be needed from your agency. Please follow the specifics instructions provided with the form. The Payee Information Form is used to establish the identity of the applicant organization and enables it to receive federal (and/or State) funds through the NYSED. An on-line version of the packet is available at NYSED s Reservation of Rights NYSED reserves the right to: (1) reject any or all proposals received in response to the RFP; (2) withdraw the RFP at any time, at the agency s sole discretion; (3) make an award under the RFP in whole or in part; (4) disqualify any bidder whose conduct and/or proposal fails to conform to the requirements of the RFP; (5) seek clarifications of proposals; (6) use proposal information obtained through site visits, management interviews and the state s investigation of a bidder s qualifications, experience, ability or financial standing, and any material or information submitted by the bidder in response to the agency s request for clarifying information in the course of evaluation and/or selection under the RFP; (7) prior to the bid opening, amend the RFP specifications to correct errors or oversights, or to supply additional information, as it becomes available; (8) prior to the bid opening, direct bidders to submit proposal modifications addressing subsequent RFP amendments; (9) change any of the scheduled dates; (10) waive any requirements that are not material; (11) negotiate with the successful bidder within the scope of the RFP in the best interests of the state; (12) conduct contract negotiations with the next responsible bidder, should the agency be unsuccessful in negotiating with the selected bidder; (13) utilize any and all ideas submitted in the proposals received; (14) unless otherwise specified in the solicitation, every offer is firm and not revocable for a period of 90 days from the bid opening; (15) require clarification at any time during the procurement process and/or require correction of arithmetic or other apparent errors for the purpose of assuring a full and complete understanding of an offerer s proposal and/or to determine an offerer s compliance with the requirements of the solicitation; (16) to request best and final offers. Vendor Responsibility State law requires that the award of state contracts be made to responsible vendors. Before an award is made to a not-for-profit entity, a for-profit entity, a private college or university or a public entity not exempted by the Office of the State Comptroller, NYSED must make an affirmative responsibility determination. The factors to be considered include: legal authority to do business in New York State; integrity; capacity- both organizational and financial; and previous performance. Before an award of $100,000 or greater can be made to a covered entity, the entity will be required to complete and submit a Vendor Responsibility Questionnaire. School districts, Charter Schools, 15

16 BOCES, public colleges and universities, public libraries, and the Research Foundation for SUNY and CUNY are some of the exempt entities. For a complete list, see: NYSED recommends that vendors file the required Vendor Responsibility Questionnaire online via the New York State VendRep System. To enroll in and use the New York State VendRep System, see the VendRep System Instructions available at or go directly to the VendRep System online at Vendors must provide their New York State Vendor Identification Number when enrolling. To request assignment of a Vendor ID or for VendRep System assistance, contact the Office of the State Comptroller s Help Desk at or or by at [email protected]. Vendors opting to complete and submit a paper questionnaire can obtain the appropriate questionnaire from the VendRep website or may contact NYSED or the Office of the State Comptroller s Help Desk for a copy of the paper form. Subcontractors: For vendors using subcontractors, a Vendor Responsibility Questionnaire and a NYSED vendor responsibility review are required for a subcontractor where: the subcontractor is known at the time of the contract award; the subcontractor is not an entity that is exempt from reporting by OSC; and the subcontract will equal or exceed $100,000 over the life of the contract. Workers Compensation Coverage and Debarment New York State Workers Compensation Law (WCL) has specific coverage requirements for businesses contracting with New York State and additional requirements which provide for the debarment of vendors that violate certain sections of WCL. The WCL requires, and has required since introduction of the law in 1922, the heads of all municipal and State entities to ensure that businesses have appropriate workers compensation and disability benefits insurance coverage prior to issuing any permits or licenses, or prior to entering into contracts. Workers compensation requirements are covered by WCL Section 57, while disability benefits are covered by WCL Section 220(8). The Workers Compensation Benefits clause in Appendix A STANDARD CLAUSES FOR NEW YORK STATE CONTRACTS states that in accordance with Section 142 of the State Finance Law, a contract shall be void and of no force and effect unless the contractor provides and maintains coverage during the life of the contract for the benefit of such employees as are required to be covered by the provisions of the WCL. Under provisions of the 2007 Workers Compensation Reform Legislation (WCL Section 141-b), any person, or entity substantially owned by that person: subject to a final 16

17 assessment of civil fines or penalties, subject to a stop-work order, or convicted of a misdemeanor for violation of Workers Compensation laws Section 52 or 131, is barred from bidding on, or being awarded, any public work contract or subcontract with the State, any municipal corporation or public body for one year for each violation. The ban is five years for each felony conviction. Proof of Coverage Requirements The Workers Compensation Board has developed several forms to assist State contracting entities in ensuring that businesses have the appropriate workers compensation and disability insurance coverage as required by Sections 57 and 220(8) of the WCL. Please note an ACORD form is not acceptable proof of New York State workers compensation or disability benefits insurance coverage. Proof of Workers Compensation Coverage To comply with coverage provisions of the WCL, the Workers Compensation Board requires that a business seeking to enter into a State contract submit appropriate proof of coverage to the State contracting entity issuing the contract. For each new contract or contract renewal, the contracting entity must obtain ONE of the following forms from the contractor and submit to OSC to prove the contractor has appropriate workers compensation insurance coverage: Form C Certificate of Workers Compensation Insurance issued by private insurance carriers, or Form U-26.3 issued by the State Insurance Fund; or Form SI-12 Certificate of Workers Compensation Self-Insurance; or Form GSI Certificate of Participation in Workers Compensation Group Self- Insurance; or CE-200 Certificate of Attestation of Exemption from NYS Workers Compensation and/or Disability Benefits Coverage. Proof of Disability Benefits Coverage To comply with coverage provisions of the WCL regarding disability benefits, the Workers Compensation Board requires that a business seeking to enter into a State contract must submit appropriate proof of coverage to the State contracting entity issuing the contract. For each new contract or contract renewal, the contracting entity must obtain ONE of the following forms from the contractor and submit to OSC to prove the contractor has appropriate disability benefits insurance coverage: Form DB Certificate of Disability Benefits Insurance; or Form DB-155- Certificate of Disability Benefits Self-Insurance; or CE-200 Certificate of Attestation of Exemption from New York State Workers Compensation and/or Disability Benefits Coverage. 17

18 For additional information regarding workers compensation and disability benefits requirements, please refer to the New York State Workers Compensation Board website at: Alternatively, questions relating to either workers compensation or disability benefits coverage should be directed to the NYS Workers Compensation Board, Bureau of Compliance at (518) Minority and Women-Owned Business Enterprise (M/WBE) Participation Goals Pursuant to Article 15-A of the New York State Executive Law The following M/WBE requirements apply when an applicant submits an application for grant funding that exceeds $25,000 for the full grant period. All forms referenced here can be found in the M/WBE Documents section at the end of this RFP. All applicants are required to comply with NYSED s Minority and Women-Owned Business Enterprises (M/WBE) policy. Compliance can be achieved by one of the three methods described below. Full participation by meeting or exceeding the M/WBE participation goal for this grant is the preferred method. M/WBE participation includes services, materials, or supplies purchased from minority and women-owned firms certified with the NYS Division of Minority and Women Business Development. Not-for-profit agencies are not eligible for this certification. For additional information and a listing of currently certified M/WBEs, see The M/WBE participation goal for this grant is 20% of each applicant s total discretionary non-personal service budget over the entire term of the grant. Discretionary non-personal service budget is defined as total budget, excluding the sum of funds budgeted for: 1. direct personal services (i.e., professional and support staff salaries) and fringe benefits; and 2. rent, lease, utilities and indirect costs, if these items are allowable expenditures. For multi-year grants, applicants should use the total budget for the full multi-year term of the grants in the above calculation. The M/WBE Goal Calculation Worksheet is provided for use in calculating the dollar amount of the M/WBE goal for this grant application. M/WBE participation does not need to be the same for each year of a multi-year grant. All requested information and documentation should be provided at the time of submission. If this cannot be done, the applicant will have thirty days from the date of notice of award to submit the necessary documents and respond satisfactorily to any follow-up questions from the Department. Failure to do so may result in loss of funding. 18

19 METHODS TO COMPLY An applicant can comply with NYSED s M/WBE policy by one of three methods: 1. Full Participation - This is the preferred method of compliance. Full participation is achieved when an applicant meets or exceeds the participation goals for this grant. COMPLETE FORMS: M/WBE Goal Calculation Worksheet M/WBE Cover Letter M/WBE 100 Utilization Plan M/WBE 102 Notice of Intent to Participate 2. Partial Participation, Partial Request for Waiver - This is acceptable only if good faith efforts to achieve full participation are made and documented, but full participation is not possible. COMPLETE FORMS: M/WBE Goal Calculation Worksheet M/WBE Cover Letter M/WBE 100 Utilization Plan M/WBE 101 Request for Waiver M/WBE 102 Notice of Intent to Participate M/WBE 105 Contractor s Good Faith Efforts 3. No Participation, Request for Complete Waiver - This is acceptable only if good faith efforts to achieve full or partial participation are made and documented, but do not result in any participation by M/WBE firm(s). COMPLETE FORMS: M/WBE Goal Calculation Worksheet M/WBE Cover Letter M/WBE 101 Request for Waiver M/WBE 105 Contractor s Good Faith Efforts GOOD FAITH EFFORTS Applicants must make a good faith effort to solicit NYS certified M/WBE firms as subcontractors and/or suppliers to achieve the goals for this grant. Solicitations may include, but are not limited to: advertisements in minority and women-centered publications; solicitation of vendors found in the NYS Directory of Certified Minority and Women-Owned Business Enterprises (see and the solicitation of minority and women-oriented trade and labor organizations. Good faith efforts include actions such as setting up meetings or announcements to make M/WBEs aware of supplier and subcontracting opportunities, identifying logical areas of the grant project that could be subcontracted to M/WBE firms, and utilizing all 19

20 current lists of M/WBEs who are available for and may be interested in subcontracting or supplying goods for the project. Applicants should document their efforts to comply with the stated M/WBE goals and submit this with their applications as evidence. Examples of acceptable documentation can be found in form M/WBE 105, Contractor s Good Faith Efforts. NYSED reserves the right to reject any application for failure to document good faith efforts. REQUEST FOR WAIVER When full participation cannot be achieved, applicants must submit a Request for Waiver (M/WBE 101). Requests for Waivers must be accompanied by documentation explaining the good faith efforts made and reasons they were unsuccessful in obtaining M/WBE participation. NYSED reserves the right to approve the addition or deletion of subcontractors or suppliers to enable applicants to comply with the M/WBE goals, provided such addition or deletion does not impact the technical proposal and/or increase the total budget. All payments to Minority and Women-Owned Business Enterprise subcontractor(s) should be reported to the NYSED M/WBE Program Unit using the M/WBE 103 Quarterly M/WBE Compliance Report. This report should be submitted on a quarterly basis and can be found at NYSED s M/WBE Coordinator is available to assist applicants in meeting the M/WBE goals. The Coordinator can be reached at [email protected]. Equal Employment Opportunity Reporting (EEO) Pursuant to Article 15-A of the New York State Executive Law Applicants must complete and submit form EEO 100: Staffing Plan. 20

21 Application Instructions Please adhere to the following instructions: Application Checklist Use the application checklist to ensure your application is submitted in the correct order and is complete. Required Signature(s) The original signature of the Chief Administrator/Officer must appear on the application cover page in blue ink. Please note: NYSED will only communicate with the contacts provided in the Application Cover Page. Page Limits and Standards Please adhere to the guidance provided to applicants below: A page is 8 x 11 (on one side only) with one-inch margins (top, bottom, and sides). Charts/tables are not required to adhere to this standard. The proposal and budget narrative should not exceed 20 pages combined; double space all text, between titles, headings, footnotes, quotations, references, and captions, as well as all text in charts, figures, and graphs unless not possible due to the formatting of the template. This limit does not apply to any of the required forms in the application including the Work Plan, Three-Year Budget Summary and FS-10 form. Each section of the Proposal Narrative should be clearly titled Use Times New Roman or Arial font in a 12-point size; Include page numbers Each page should include a header with the applicant s name. Applications should include an Application Checklist and the following components: Grant Application Cover Page Grant Application Checklist Proposal Narrative Template A Work Plan Template Template B -Three-year Budget Summary FS-10 Budget Form (for the first year only) with original signature from Chief Administrative Officer, available at Budget Narrative Worker s Compensation Documentation (encouraged) Disability Benefits Documentation (encouraged) 21

22 M/WBE Document Package Applicants must submit one signed original and three copies of the full proposal to the Department. Applicants must also submit one complete copy of the application on a compact disc or flash drive. Fax transmissions are not acceptable. To be considered for funding, proposals must be postmarked no later than the due date. Proposals postmarked after the due date will not be reviewed. 22

23 Program Development Grant to Prepare Students with Disabilities to Exit School with Work Readiness Skills Application Cover Page Agency Code Name Applicant agency: Name and Title of Contact Person: Address: Telephone: Fax: City: Zip Code: County: I hereby certify that I am the applicant s chief school/administrative officer and that the information contained in this application is, to the best of my knowledge, complete and accurate. I further certify, to the best of my knowledge, that any ensuing program and activity will be conducted in accordance with all applicable Federal and State laws and regulations, application guidelines and instructions, Assurances, Certifications, Appendix A, Appendix A-1G and that the requested budget amounts are necessary for the implementation of this project. It is understood by the applicant that this application constitutes an offer and, if accepted by the NYS Education Department or renegotiated to acceptance, will form a binding agreement. It is also understood by the applicant that immediate written notice will be provided to the grant program office if at any time the applicant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 23

24 Original Signature of Chief Administrative Officer (in blue ink) Typed Name of Chief Administrative Officer: Date: 24

25 Application Checklist Applicant Name A complete application consists of all of the following items submitted in the following order. Application Components Checked Applicant Payee Information Form/NYSED Substitute W-9 Form (if applicable) See: Application Checklist Checked SED Application Cover Page Proposal Narrative Template A Work Plan Template B Three-Year Budget Summary Budget Narrative FS-10 Budget for first year only July 1, 2015 to June 30, 2016 (requires original signature) Worker s Compensation Documentation (encouraged) Disability Benefits Documentation (encouraged) If a not-for-profit, is the applicant prequalified,? (While no documentation is required with the application, non-profit applicants may need to prequalify in order to be eligible for this grant opportunity). See Prequalification Section in this RFP. Yes No 25

26 If no, you are not eligible to apply. M/WBE Documents Package (original signatures required) Full Participation Request Partial Waiver Request Total Waiver Forms Required Type of Form M/WBE Cover Letter Full Participation Request Partial Waiver Request Total Waiver M/WBE 100 Utilization Plan N/A M/WBE 102 Notice of Intent to Participate N/A EEO 100 Staffing Plan and Instructions M/WBE 105 Contractor s Good Faith Efforts N/A M/WBE 101 Request for Waiver Form and Instructions N/A 26

27 Template A Program Development Grant to Prepare Students with Disabilities to Exit School with Work Readiness Skills Applicant: Work Plan Deliverable: Develop new or expand existing career and technical education courses and/or work-based learning programs for students with disabilities and/or expand supports to students to engage in career planning and ensure appropriate development and implementation of transition programs and services for students with disabilities to develop their work readiness knowledge and skills Specific Activities to Address Deliverable Measurable Goal Timeline Staff Responsible *add more lines as necessary Deliverable: Meet periodically with and compile reports on the participation and outcome of stakeholder consultation in improving the school s instructional and work-based learning programs leading to awards of the CDOS Commencement Credential. Specific Activities to Address Deliverable Measurable Goal Timeline Staff Responsible 27

28 *add more lines as necessary Deliverable: Provide professional development and leadership actions to develop and sustain the changes to the school s work readiness instructional programs and activities. Specific Activities to Address Deliverable Measurable Goal Timeline Staff Responsible *add more lines as necessary Deliverable: Develop and implement a plan to enhance the school s infrastructure to provide increased opportunities for students with disabilities to exit school with the CDOS Commencement Credential. Specific Activities to Address Deliverable Measurable Goal Timeline Staff Responsible *add more lines as necessary 28

29 Use this form to provide the proposed three-year budget. Template B - Three-Year Budget Summary Budget Category 9/1/2015-6/30/2016 7/1/2016-6/30/2017 7/1/2017-6/30/2018 TOTAL 1. Salaries for Professional Staff 2. Salaries for Support Staff 3. Purchased Services 4. Materials and Supplies 5. Travel Expenses 6. Employee Benefits 7. Indirect Cost 8. Purchased Services with BOCES 9. Minor Remodeling 10. Equipment Total 29

30 IDEA Part B: Program Development Grant September 1, 2015 June 30, 2018 Scoring Rubric Applicant: Total Score: Reviewer Initials: Rating Guidelines: Very Good Good Fair Poor Comprehensive and thorough with outstanding quality. Response addresses criteria completely, and articulates specific detail clearly. Well-conceived and developed ideas. General but sufficient detail. Adequate information but lacks specificity and detail. Some areas are not fully explained or elaborated. Some minor inconsistencies and weaknesses are evident. Non-specific and lacks focus and detail. Response addresses some criteria with limited information supporting specific ideas but required elements of the proposal are minimally met. Does not meet the criteria, provides inaccurate information, or provides information that requires substantial clarification as to how the criteria are met; lacks meaningful detail; demonstrates lack of preparation. 30

31 Scoring Rubric Proposal Narrative Abstract (0 points) Provides a succinct and concise overview of the proposal as a whole. Describes how funds will be used to maximize opportunities for students with disabilities to engage in meaningful career planning and work-based learning experiences. Subtotal ( N/A ) out of 0 points Proposal Narrative Need for Project (15 Very Good Good Fair Poor points) Applicant describes the extent to which the applicant currently offers integrated and/or specialized CTE coursework and work-based learning experiences is described. Applicant explains the extent to which students with disabilities currently participate in such programs Applicant explains how grant funds will be essential to implementation of work-based learning and educational programs to support students with disabilities access and progress in the general education curriculum and the attainment of the CDOS Commencement Credential Rater s Comments: Subtotal ( ) out of 15 points 31

32 Proposal Narrative Project Design (25 points) Very Good Good Fair Poor Applicant describes appropriate goals, objectives and activities of the proposed project, including how the applicant will (1) develop new or expand existing career and technical education courses and/or workbased learning programs for students with disabilities; and/or (2) expand supports to students to engage in career planning; and (3) ensure appropriate development and implementation of transition programs and services for students with disabilities to develop their work readiness knowledge and skills Applicant describes how they will meet periodically with stakeholders and compile reports on the participation and outcome of stakeholder consultation in improving the school s instructional and work-based learning programs leading to awards of the CDOS Commencement Credential. Applicant provides a clear description of the provision of professional development and leadership actions to develop and sustain the changes to the school s work readiness instructional programs and activities is provided. Applicant provides a detailed plan to enhance the school s infrastructure to provide increased opportunities for students with disabilities to exit school with the CDOS Commencement Credential. Applicant describes an effective plan for sustainability of the work of the project beyond the grant-funded years is provided, including a plan for retention of new or dedicated staff that work on the project. Rater s Comments: Subtotal ( ) out of 25 points 32

33 Proposal Narrative Work Plan (20 points) Very Good Good Fair Poor Specific activities of the project as outlined in the project design are provided. Measurable goals for each activity are included Timelines for each activity are provided and are reasonable. Applicant identifies the staff responsible for each activity and the achievement of goals. Rater s Comments: Subtotal ( ) out of 20 points Proposal Narrative Project Evaluation (5 points) Applicant provides a plan to evaluate the effectiveness of the project. Rater s Comments: Very Good Good Fair Poor Subtotal ( ) out of 5 points Proposal Narrative Project Personnel (5 Very Good Good Fair Poor points) Applicant identifies the project personnel and their roles and responsibilities related to the work Qualifications of each staff member are provided (including education, training and experience) Applicant provides a justification for each staff member as to how that person is qualified to implement the particular project activity to which they are assigned. Rater s Comments: Subtotal ( ) out of 5 points 33

34 Proposal Narrative Organizational Capacity (10 points) Applicant s experience and/or current capacity to fulfill the commitments outlined in the proposal is described. Specific collaborations to be established with community partners such as institutions of higher education, community-based organizations, adult service agencies, employers and business organizations are described. Rater s Comments: Very Good Good Fair Poor Subtotal ( ) out of 10 points Proposal Narrative Budget and Budget Very Good Good Fair Poor Narrative (20 points) Unallowable or inappropriate expenditure(s) will be eliminated and reflected in the score of the budget. The budget will be evaluated based on: An overall proposed expenditure plan in the form of a budget narrative that describes proposed expenditures over the 3-year period that are appropriate, reasonable and necessary to support the project activities and goals. Proposed expenditures over a 3-year period clearly support project activities. Described expenditures and activities are supplemental to and do not supplant or duplicate services currently provided. Rater s Comments: Subtotal ( ) out of 20 points 34

35 New York State Education Department Assurances for Federal Discretionary Program Funds The following assurances are a component of your application. By signing the certification on the application cover page you are ensuring accountability and compliance with State and federal laws, regulations, and grants management requirements. Federal Assurances and Certifications, General: Assurances Non-Construction Programs Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions General Education Provisions Act Assurances Federal Assurances and Certifications, NCLB (if appropriate): The following are required as a condition for receiving any federal funds under the Elementary and Secondary Education Act, as amended by the No Child Left Behind Act of NCLB Assurances School Prayer Certification 35

36 ASSURANCES - NON-CONSTRUCTION PROGRAMS Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the Education Department Program Contact listed in the Application. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant, and by signing the Application Cover Page, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C ) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L ) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C , and ), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C ), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L ), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L ), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) '' 523 and 527 of 36

37 the Public Health Service Act of 1912 (42 U.S.C. '' 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L ) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C and ), which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C ), regarding labor standards for federally assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L ) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L ) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C et seq.); (f) conformity of Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L ); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L ). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO (identification 37

38 and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.). 14. Will comply with P.L regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L , as amended, 7 U.S.C et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C et seq.), which prohibits the use of lead-based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, Audits of States, Local Governments, and Non-Profit Organizations. 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program. Standard Form 424B (Rev. 7-97), Prescribed by OMB Circular A-102, Authorized for Local Reproduction, as amended by New York State Education Department CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature of the Application Cover Page provides for compliance with certification requirements under 34 CFR Part 82, "New Restrictions on Lobbying," and 34 CFR Part 85, "Government-wide Debarment and Suspension (Nonprocurement)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Education determines to award the covered transaction, grant, or cooperative agreement. 1. LOBBYING As required by Section 1352, Title 31 of the U.S. Code, and implemented at 34 CFR Part 82, for persons entering into a grant or cooperative agreement over $100,000, as defined at 34 CFR Part 82, Sections and , the applicant certifies that: a. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or 38

39 an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement: b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; and c. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly. 2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS As required by Executive Order 12549, Debarment and Suspension, and implemented at 34 CFR Part 85, for prospective participants in primary covered transactions, as defined at 34 CFR Part 85, Sections and A. The applicant certifies that it and its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; b. Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (2)(b) of this certification; and d. Have not within a three-year period preceding this application had one or more public transaction (Federal, State, or local) terminated for cause or default; and B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application. ED , as amended by the New York State Education Department CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS 39

40 This certification is required by the Department of Education regulations implementing Executive Order 12549, Debarment and Suspension, 34 CFR Part 85, for all lower tier transactions meeting the threshold and tier requirements stated at Section Instructions for Certification 1. By signing the Application Cover Page, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include the clause titled Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion-Lower Tier Covered Transactions, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this 40

41 clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment Certification 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. ED , as amended by the New York State Education Department NEW YORK STATE DEPARTMENT OF EDUCATION GENERAL EDUCATION PROVISIONS ACT ASSURANCES These assurances are required by the General Education Provisions Act for certain programs funded by the U.S. Department of Education. These assurances are not applicable to certain programs, such as the No Child Left Behind Act. If you have any questions, please contact NYSED. As the authorized representative of the applicant, by signing the Application Cover Page, I certify that: 1. the local educational agency will administer each program covered by the application in accordance with all applicable statutes, regulations, program plans, and applications; 2. the control of funds provided to the local educational agency under each program, and title to property acquired with those funds, will be in a public agency and that a public agency will administer those funds and property; 41

42 3. the local educational agency will use fiscal control and fund accounting procedures that will ensure proper disbursement of, and accounting for, Federal funds paid to that agency under each program; 4. the local educational agency will make reports to the State agency or board and to the Secretary as may reasonably be necessary to enable the State agency or board and the Secretary to perform their duties and that the local educational agency will maintain such records, including the records required under section 1232f of this title, and provide access to those records, as the State agency or board or the Secretary deem necessary to perform their duties; 5. the local educational agency will provide reasonable opportunities for the participation by teachers, parents, and other interested agencies, organizations, and individuals in the planning for and operation of each program; 6. any application, evaluation, periodic program plan or report relating to each program will be made readily available to parents and other members of the general public; 7. in the case of any project involving construction - a. the project is not inconsistent with overall State plans for the construction of school facilities, and b. in developing plans for construction, due consideration will be given to excellence of architecture and design and to compliance with standards prescribed by the Secretary under section 794 of title 29in order to ensure that facilities constructed with the use of Federal funds are accessible to and usable by individuals with disabilities; 8. the local educational agency has adopted effective procedures for acquiring and disseminating to teachers and administrators participating in each program significant information from educational research, demonstrations, and similar projects, and for adopting, where appropriate, promising educational practices developed through such projects; and 9. none of the funds expended under any applicable program will be used to acquire equipment (including computer software) in any instance in which such acquisition results in a direct financial benefit to any organization representing the interests of the purchasing entity or its employees or any affiliate of such an organization. NEW YORK STATE DEPARTMENT OF EDUCATION NO CHILD LEFT BEHIND ACT ASSURANCES These assurances are required for programs funded under the No Child Left Behind Act. 42

43 As the authorized representative of the applicant, by signing the Application Cover Page, I certify that: 1. each such program will be administered in accordance with all applicable statutes, regulations, program plans, and applications; 2. the control of funds provided under each such program and title to property acquired with program funds will be in a public agency or in a nonprofit private agency, institution, organization, or Indian tribe, if the law authorizing the program provides for assistance to those entities; and the public agency, nonprofit private agency, institution, or organization, or Indian tribe will administer the funds and property to the extent required by the authorizing statutes; 3. the applicant will adopt and use proper methods of administering each such program, including - a. the enforcement of any obligations imposed by law on agencies, institutions, organizations, and other recipients responsible for carrying out each program; and b. the correction of deficiencies in program operations that are identified through audits, monitoring, or evaluation; 4. the applicant will cooperate in carrying out any evaluation of each such program conducted by or for the State educational agency, the Secretary, or other Federal officials; 5. the applicant will use such fiscal control and fund accounting procedures as will ensure proper disbursement of, and accounting for, Federal funds paid to the applicant under each such program; 6. the applicant will - a. submit such reports to the State educational agency (which shall make the reports available to the Governor) and the Secretary as the State educational agency and Secretary may require to enable the State educational agency and the Secretary to perform their duties under each such program; and b. maintain such records, provide such information, and afford such access to the records as the State educational agency (after consultation with the Governor) or the Secretary may reasonably require to carry out the State educational agency s or the Secretary s duties; 7. before the application was submitted, the applicant afforded a reasonable opportunity for public comment on the application and considered such comment; 43

44 8. the applicant has consulted with teachers, school administrators, parents, nonpublic school representatives and others in the development of the application to the extent required for the applicant under the program pursuant to the applicable provisions of the No Child Left Behind Act; 9. in the case of a local educational agency, as a condition of receiving funds under the No Child Left Behind Act, the applicant is complying with the requirements of Education Law 3214(3)(d) and (f) and the Gun-Free Schools Act (20 U.S.C. 7151); 10. in the case of a local educational agency, as a condition of receiving funds under the No Child Left Behind Act, the applicant is complying with the requirements of 20 U.S.C on military recruiter access; 11. in the case of a local educational agency, as a condition of receiving funds under the No Child Left Behind Act, the applicant is complying with the requirements of 20 U.S.C on constitutionally protected prayer in public elementary and secondary schools; 12. in the case of a local educational agency, as a condition of receiving funds under the No Child Left Behind Act, the applicant is complying with the requirements of Education Law 2802(7), and any state regulations implementing such statute and 20 U.S.C on unsafe school choice; and 13. in the case of a local educational agency, the applicant is complying with all fiscal requirements that apply to the program, including but not limited to any applicable supplement not supplant or local maintenance of effort requirements. SCHOOL PRAYER CERTIFICATION As a condition of receiving federal funds under the Elementary and Secondary Education Act, as amended by the No Child Left Behind Act of 2001 (NCLB), the local educational agency hereby certifies that no policy of the local educational agency prevents, or otherwise denies participation in, constitutionally protected prayer in public elementary schools and secondary schools, as detailed in the current guidance issued pursuant to NCLB Section 9524(a). 44

45 Appendix A STANDARD CLAUSES FOR NYS CONTRACTS The parties to the attached contract, license, lease, amendment or other agreement of any kind (hereinafter, "the contract" or "this contract") agree to be bound by the following clauses which are hereby made a part of the contract (the word "Contractor" herein refers to any party other than the State, whether a contractor, licenser, licensee, lessor, lessee or any other party): amended, exceeds said statutory amount, or if, by this contract, the State agrees to give something other than money when the value or reasonably estimated value of such consideration exceeds $10,000, it shall not be valid, effective or binding upon the State until it has been approved by the State Comptroller and filed in his office. Comptroller's approval of contracts let by the Office of General Services is required when such contracts exceed $85,000 (State Finance Law Section a). However, such pre-approval shall not be required for any contract established as a centralized contract through the Office of General Services or for a purchase order or other transaction issued under such centralized contract. 1. EXECUTORY CLAUSE. In accordance with Section 41 of the State Finance Law, the State shall have no liability under this contract to the Contractor or to anyone else beyond funds appropriated and available for this contract. 2. NON-ASSIGNMENT CLAUSE. In accordance with Section 138 of the State Finance Law, this contract may not be assigned by the Contractor or its right, title or interest therein assigned, transferred, conveyed, sublet or otherwise disposed of without the State s previous written consent, and attempts to do so are null and void. Notwithstanding the foregoing, such prior written consent of an assignment of a contract let pursuant to Article XI of the State Finance Law may be waived at the discretion of the contracting agency and with the concurrence of the State Comptroller where the original contract was subject to the State Comptroller s approval, where the assignment is due to a reorganization, merger or consolidation of the Contractor s business entity or enterprise. The State retains its right to approve an assignment and to require that any Contractor demonstrate its responsibility to do business with the State. The Contractor may, however, assign its right to receive payments without the State s prior written consent unless this contract concerns Certificates of Participation pursuant to Article 5-A of the State Finance Law. 3. COMPTROLLER'S APPROVAL. In accordance with Section 112 of the State Finance Law (or, if this contract is with the State University or City University of New York, Section 355 or Section 6218 of the Education Law), if this contract exceeds $50,000 (or the minimum thresholds agreed to by the Office of the State Comptroller for certain S.U.N.Y. and C.U.N.Y. contracts), or if this is an amendment for any amount to a contract which, as so 4. WORKERS' COMPENSATION BENEFITS. In accordance with Section 142 of the State Finance Law, this contract shall be void and of no force and effect unless the Contractor shall provide and maintain coverage during the life of this contract for the benefit of such employees as are required to be covered by the provisions of the Workers' Compensation Law. 5. NON-DISCRIMINATION REQUIREMENTS. To the extent required by Article 15 of the Executive Law (also known as the Human Rights Law) and all other State and Federal statutory and constitutional non-discrimination provisions, the Contractor will not discriminate against any employee or applicant for employment because of race, creed, color, sex (including gender identity or expression), national origin, sexual orientation, military status, age, disability, predisposing genetic characteristics, marital status or domestic violence victim status. Furthermore, in accordance with Section 220-e of the Labor Law, if this is a contract for the construction, alteration or repair of any public building or public work or for the manufacture, sale or distribution of materials, equipment or supplies, and to the extent that this contract shall be performed within the State of New York, Contractor agrees that neither it nor its subcontractors shall, by reason of race, creed, color, disability, sex, or national origin: (a) discriminate in hiring against any New York State citizen who is qualified and available to perform the work; or (b) discriminate against or intimidate any employee hired for the performance of work under this contract. If this is a building service contract as defined in Section 230 of the Labor Law, then, in accordance with Section 239 thereof, Contractor agrees that neither it nor its subcontractors shall by reason of race, creed, color, national origin, age, sex or disability: (a) discriminate in hiring against any New York State citizen who is qualified and available to perform the work; or (b) discriminate 45

46 against or intimidate any employee hired for the performance of work under this contract. Contractor is subject to fines of $50.00 per person per day for any violation of Section 220-e or Section 239 as well as possible termination of this contract and forfeiture of all moneys due hereunder for a second or subsequent violation. 6. WAGE AND HOURS PROVISIONS. If this is a public work contract covered by Article 8 of the Labor Law or a building service contract covered by Article 9 thereof, neither Contractor's employees nor the employees of its subcontractors may be required or permitted to work more than the number of hours or days stated in said statutes, except as otherwise provided in the Labor Law and as set forth in prevailing wage and supplement schedules issued by the State Labor Department. Furthermore, Contractor and its subcontractors must pay at least the prevailing wage rate and pay or provide the prevailing supplements, including the premium rates for overtime pay, as determined by the State Labor Department in accordance with the Labor Law. Additionally, effective April 28, 2008, if this is a public work contract covered by Article 8 of the Labor Law, the Contractor understands and agrees that the filing of payrolls in a manner consistent with Subdivision 3-a of Section 220 of the Labor Law shall be a condition precedent to payment by the State of any State approved sums due and owing for work done upon the project. Sections 2401 et seq.) or regulations thereunder. If such Contractor, or any of the aforesaid affiliates of Contractor, is convicted or is otherwise found to have violated said laws or regulations upon the final determination of the United States Commerce Department or any other appropriate agency of the United States subsequent to the contract's execution, such contract, amendment or modification thereto shall be rendered forfeit and void. The Contractor shall so notify the State Comptroller within five (5) business days of such conviction, determination or disposition of appeal (2NYCRR 105.4). 9. SET-OFF RIGHTS. The State shall have all of its common law, equitable and statutory rights of set-off. These rights shall include, but not be limited to, the State's option to withhold for the purposes of set-off any moneys due to the Contractor under this contract up to any amounts due and owing to the State with regard to this contract, any other contract with any State department or agency, including any contract for a term commencing prior to the term of this contract, plus any amounts due and owing to the State for any other reason including, without limitation, tax delinquencies, fee delinquencies or monetary penalties relative thereto. The State shall exercise its set-off rights in accordance with normal State practices including, in cases of set-off pursuant to an audit, the finalization of such audit by the State agency, its representatives, or the State Comptroller. 7. NON-COLLUSIVE BIDDING CERTIFICATION. In accordance with Section 139-d of the State Finance Law, if this contract was awarded based upon the submission of bids, Contractor affirms, under penalty of perjury, that its bid was arrived at independently and without collusion aimed at restricting competition. Contractor further affirms that, at the time Contractor submitted its bid, an authorized and responsible person executed and delivered to the State a non-collusive bidding certification on Contractor's behalf. 8. INTERNATIONAL BOYCOTT PROHIBITION. In accordance with Section 220-f of the Labor Law and Section 139-h of the State Finance Law, if this contract exceeds $5,000, the Contractor agrees, as a material condition of the contract, that neither the Contractor nor any substantially owned or affiliated person, firm, partnership or corporation has participated, is participating, or shall participate in an international boycott in violation of the federal Export Administration Act of 1979 (50 USC App. 10. RECORDS. The Contractor shall establish and maintain complete and accurate books, records, documents, accounts and other evidence directly pertinent to performance under this contract (hereinafter, collectively, "the Records"). The Records must be kept for the balance of the calendar year in which they were made and for six (6) additional years thereafter. The State Comptroller, the Attorney General and any other person or entity authorized to conduct an examination, as well as the agency or agencies involved in this contract, shall have access to the Records during normal business hours at an office of the Contractor within the State of New York or, if no such office is available, at a mutually agreeable and reasonable venue within the State, for the term specified above for the purposes of inspection, auditing and copying. The State shall take reasonable steps to protect from public disclosure any of the Records which are exempt from disclosure under Section 87 of the Public Officers Law (the "Statute") provided that: (i) the Contractor shall timely inform an appropriate State official, in writing, that said records should not be disclosed; and (ii) said 46

47 records shall be sufficiently identified; and (iii) designation of said records as exempt under the Statute is reasonable. Nothing contained herein shall diminish, or in any way adversely affect, the State's right to discovery in any pending or future litigation. 11. IDENTIFYING INFORMATION AND PRIVACY NOTIFICATION. (a) Identification Number(s). Every invoice or New York State Claim for Payment submitted to a New York State agency by a payee, for payment for the sale of goods or services or for transactions (e.g., leases, easements, licenses, etc.) related to real or personal property must include the payee's identification number. The number is any or all of the following: (i) the payee s Federal employer identification number, (ii) the payee s Federal social security number, and/or (iii) the payee s Vendor Identification Number assigned by the Statewide Financial System. Failure to include such number or numbers may delay payment. Where the payee does not have such number or numbers, the payee, on its invoice or Claim for Payment, must give the reason or reasons why the payee does not have such number or numbers. (b) Privacy Notification. (1) The authority to request the above personal information from a seller of goods or services or a lessor of real or personal property, and the authority to maintain such information, is found in Section 5 of the State Tax Law. Disclosure of this information by the seller or lessor to the State is mandatory. The principal purpose for which the information is collected is to enable the State to identify individuals, businesses and others who have been delinquent in filing tax returns or may have understated their tax liabilities and to generally identify persons affected by the taxes administered by the Commissioner of Taxation and Finance. The information will be used for tax administration purposes and for any other purpose authorized by law. (2) The personal information is requested by the purchasing unit of the agency contracting to purchase the goods or services or lease the real or personal property covered by this contract or lease. The information is maintained in the Statewide Financial System by the Vendor Management Unit within the Bureau of State Expenditures, Office of the State Comptroller, 110 State Street, Albany, New York the contracting agency; or (ii) a written agreement in excess of $100, whereby a contracting agency is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon; or (iii) a written agreement in excess of $100, whereby the owner of a State assisted housing project is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon for such project, then the following shall apply and by signing this agreement the Contractor certifies and affirms that it is Contractor s equal employment opportunity policy that: (a) The Contractor will not discriminate against employees or applicants for employment because of race, creed, color, national origin, sex, age, disability or marital status, shall make and document its conscientious and active efforts to employ and utilize minority group members and women in its work force on State contracts and will undertake or continue existing programs of affirmative action to ensure that minority group members and women are afforded equal employment opportunities without discrimination. Affirmative action shall mean recruitment, employment, job assignment, promotion, upgradings, demotion, transfer, layoff, or termination and rates of pay or other forms of compensation; (b) at the request of the contracting agency, the Contractor shall request each employment agency, labor union, or authorized representative of workers with which it has a collective bargaining or other agreement or understanding, to furnish a written statement that such employment agency, labor union or representative will not discriminate on the basis of race, creed, color, national origin, sex, age, disability or marital status and that such union or representative will affirmatively cooperate in the implementation of the Contractor's obligations herein; and 12. EQUAL EMPLOYMENT OPPORTUNITIES FOR MINORITIES AND WOMEN. In accordance with Section 312 of the Executive Law and 5 NYCRR 143, if this contract is: (i) a written agreement or purchase order instrument, providing for a total expenditure in excess of $25,000.00, whereby a contracting agency is committed to expend or does expend funds in return for labor, services, supplies, equipment, materials or any combination of the foregoing, to be performed for, or rendered or furnished to (c) the Contractor shall state, in all solicitations or advertisements for employees, that, in the performance of the State contract, all qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status. 47

48 Contractor will include the provisions of "a", "b", and "c" above, in every subcontract over $25, for the construction, demolition, replacement, major repair, renovation, planning or design of real property and improvements thereon (the "Work") except where the Work is for the beneficial use of the Contractor. Section 312 does not apply to: (i) work, goods or services unrelated to this contract; or (ii) employment outside New York State. The State shall consider compliance by a contractor or subcontractor with the requirements of any federal law concerning equal employment opportunity which effectuates the purpose of this section. The contracting agency shall determine whether the imposition of the requirements of the provisions hereof duplicate or conflict with any such federal law and if such duplication or conflict exists, the contracting agency shall waive the applicability of Section 312 to the extent of such duplication or conflict. Contractor will comply with all duly promulgated and lawful rules and regulations of the Department of Economic Development s Division of Minority and Women's Business Development pertaining hereto. 13. CONFLICTING TERMS. In the event of a conflict between the terms of the contract (including any and all attachments thereto and amendments thereof) and the terms of this Appendix A, the terms of this Appendix A shall control. 14. GOVERNING LAW. This contract shall be governed by the laws of the State of New York except where the Federal supremacy clause requires otherwise. 15. LATE PAYMENT. Timeliness of payment and any interest to be paid to Contractor for late payment shall be governed by Article 11-A of the State Finance Law to the extent required by law. 17. SERVICE OF PROCESS. In addition to the methods of service allowed by the State Civil Practice Law & Rules ("CPLR"), Contractor hereby consents to service of process upon it by registered or certified mail, return receipt requested. Service hereunder shall be complete upon Contractor's actual receipt of process or upon the State's receipt of the return thereof by the United States Postal Service as refused or undeliverable. Contractor must promptly notify the State, in writing, of each and every change of address to which service of process can be made. Service by the State to the last known address shall be sufficient. Contractor will have thirty (30) calendar days after service hereunder is complete in which to respond. 18. PROHIBITION ON PURCHASE OF TROPICAL HARDWOODS. The Contractor certifies and warrants that all wood products to be used under this contract award will be in accordance with, but not limited to, the specifications and provisions of Section 165 of the State Finance Law, (Use of Tropical Hardwoods) which prohibits purchase and use of tropical hardwoods, unless specifically exempted, by the State or any governmental agency or political subdivision or public benefit corporation. Qualification for an exemption under this law will be the responsibility of the contractor to establish to meet with the approval of the State. In addition, when any portion of this contract involving the use of woods, whether supply or installation, is to be performed by any subcontractor, the prime Contractor will indicate and certify in the submitted bid proposal that the subcontractor has been informed and is in compliance with specifications and provisions regarding use of tropical hardwoods as detailed in 165 State Finance Law. Any such use must meet with the approval of the State; otherwise, the bid may not be considered responsive. Under bidder certifications, proof of qualification for exemption will be the responsibility of the Contractor to meet with the approval of the State. 16. NO ARBITRATION. Disputes involving this contract, including the breach or alleged breach thereof, may not be submitted to binding arbitration (except where statutorily authorized), but must, instead, be heard in a court of competent jurisdiction of the State of New York. 19. MACBRIDE FAIR EMPLOYMENT PRINCIPLES. In accordance with the MacBride Fair Employment Principles (Chapter 807 of the Laws of 1992), the Contractor hereby stipulates that the Contractor either (a) has no business operations in Northern Ireland, or (b) shall take lawful steps in good faith to conduct any business operations in Northern Ireland in accordance with the MacBride Fair Employment Principles (as described in Section 165 of the New York State Finance Law), and shall 48

49 permit independent monitoring of compliance with such principles. 20. OMNIBUS PROCUREMENT ACT OF It is the policy of New York State to maximize opportunities for the participation of New York State business enterprises, including minority and women-owned business enterprises as bidders, subcontractors and suppliers on its procurement contracts. (a) The Contractor has made reasonable efforts to encourage the participation of New York State Business Enterprises as suppliers and subcontractors, including certified minority and women-owned business enterprises, on this project, and has retained the documentation of these efforts to be provided upon request to the State; (b) The Contractor has complied with the Federal Equal Opportunity Act of 1972 (P.L ), as amended; Information on the availability of New York State subcontractors and suppliers is available from: NYS Department of Economic Development Division for Small Business Albany, New York Telephone: Fax: A directory of certified minority and women-owned business enterprises is available from: NYS Department of Economic Development Division of Minority and Women's Business Development 633 Third Avenue New York, NY lic.asp The Omnibus Procurement Act of 1992 requires that by signing this bid proposal or contract, as applicable, Contractors certify that whenever the total bid amount is greater than $1 million: (c) The Contractor agrees to make reasonable efforts to provide notification to New York State residents of employment opportunities on this project through listing any such positions with the Job Service Division of the New York State Department of Labor, or providing such notification in such manner as is consistent with existing collective bargaining contracts or agreements. The Contractor agrees to document these efforts and to provide said documentation to the State upon request; and (d) The Contractor acknowledges notice that the State may seek to obtain offset credits from foreign countries as a result of this contract and agrees to cooperate with the State in these efforts. 21. RECIPROCITY AND SANCTIONS PROVISIONS. Bidders are hereby notified that if their principal place of business is located in a country, nation, province, state or political subdivision that penalizes New York State vendors, and if the goods or services they offer will be substantially produced or performed outside New York State, the Omnibus Procurement Act 1994 and 2000 amendments (Chapter 684 and Chapter 383, respectively) require that they be denied contracts which they would otherwise obtain. NOTE: As of May 15, 2002, the list of discriminatory jurisdictions subject to this provision includes the states of South Carolina, Alaska, West Virginia, Wyoming, Louisiana and Hawaii. Contact NYS Department of Economic Development for a current list of jurisdictions subject to this provision. 22. COMPLIANCE WITH NEW YORK STATE INFORMATION SECURITY BREACH AND NOTIFICATION ACT. Contractor shall comply with the provisions of the New York State Information 49

50 Security Breach and Notification Act (General Business Law Section 899-aa; State Technology Law Section 208). 23. COMPLIANCE WITH CONSULTANT DISCLOSURE LAW. If this is a contract for consulting services, defined for purposes of this requirement to include analysis, evaluation, research, training, data processing, computer programming, engineering, environmental, health, and mental health services, accounting, auditing, paralegal, legal or similar services, then, in accordance with Section 163 (4-g) of the State Finance Law (as amended by Chapter 10 of the Laws of 2006), the Contractor shall timely, accurately and properly comply with the requirement to submit an annual employment report for the contract to the agency that awarded the contract, the Department of Civil Service and the State Comptroller. 26. IRAN DIVESTMENT ACT. By entering into this Agreement, Contractor certifies in accordance with State Finance Law 165- a that it is not on the Entities Determined to be Non- Responsive Bidders/Offerers pursuant to the New York State Iran Divestment Act of 2012 ( Prohibited Entities List ) posted at: Contractor further certifies that it will not utilize on this Contract any subcontractor that is identified on the Prohibited Entities List. Contractor agrees that should it seek to renew or extend this Contract, it must provide the same certification at the time the Contract is renewed or extended. Contractor also agrees that any proposed Assignee of this Contract will be required to certify that it is not on the Prohibited Entities List before the contract assignment will be approved by the State. 24. PROCUREMENT LOBBYING. To the extent this agreement is a "procurement contract" as defined by State Finance Law Sections 139-j and 139-k, by signing this agreement the contractor certifies and affirms that all disclosures made in accordance with State Finance Law Sections 139-j and 139-k are complete, true and accurate. In the event such certification is found to be intentionally false or intentionally incomplete, the State may terminate the agreement by providing written notification to the Contractor in accordance with the terms of the agreement. 25. CERTIFICATION OF REGISTRATION TO COLLECT SALES AND COMPENSATING USE TAX BY CERTAIN STATE CONTRACTORS, AFFILIATES AND SUBCONTRACTORS. To the extent this agreement is a contract as defined by Tax Law Section 5-a, if the contractor fails to make the certification required by Tax Law Section 5-a or if during the term of the contract, the Department of Taxation and Finance or the covered agency, as defined by Tax Law 5-a, discovers that the certification, made under penalty of perjury, is false, then such failure to file or false certification shall be a material breach of this contract and this contract may be terminated, by providing written notification to the Contractor in accordance with the terms of the agreement, if the covered agency determines that such action is in the best interest of the State. During the term of the Contract, should the state agency receive information that a person (as defined in State Finance Law 165- a) is in violation of the above-referenced certifications, the state agency will review such information and offer the person an opportunity to respond. If the person fails to demonstrate that it has ceased its engagement in the investment activity which is in violation of the Act within 90 days after the determination of such violation, then the state agency shall take such action as may be appropriate and provided for by law, rule, or contract, including, but not limited to, imposing sanctions, seeking compliance, recovering damages, or declaring the Contractor in default. The state agency reserves the right to reject any bid, request for assignment, renewal or extension for an entity that appears on the Prohibited Entities List prior to the award, assignment, renewal or extension of a contract, and to pursue a responsibility review with respect to any entity that is awarded a contract and appears on the Prohibited Entities list after contract award. (January 2014) 50

51 APPENDIX A-1 G General A. In the event that the Contractor shall receive, from any source whatsoever, sums the payment of which is in consideration for the same costs and services provided to the State, the monetary obligation of the State hereunder shall be reduced by an equivalent amount provided, however, that nothing contained herein shall require such reimbursement where additional similar services are provided and no duplicative payments are received. B. This agreement is subject to applicable Federal and State Laws and regulations and the policies and procedures stipulated in the NYS Education Department Fiscal Guidelines found at C. For each individual for whom costs are claimed under this agreement, the contractor warrants that the individual has been classified as an employee or as an independent contractor in accordance with 2 NYCRR 315 and all applicable laws including, but not limited to, the Internal Revenue Code, the New York Retirement and Social Security Law, the New York Education Law, the New York Labor Law, and the New York Tax Law. Furthermore, the contractor warrants that all project funds allocated to the proposed budget for Employee Benefits, represent costs for employees of the contractor only and that such funds will not be expended on any individual classified as an independent contractor. D. Any modification to this Agreement that will result in a transfer of funds among program activities or budget cost categories, but does not affect the amount, consideration, scope or other terms of this Agreement must be approved by the Commissioner of Education and the Office of the State Comptroller when: a. The amount of the modification is equal to or greater than ten percent of the total value of the contract for contracts of less than five million dollars; or b. The amount of the modification is equal to or greater than five percent of the total value of the contract for contracts of more than five million dollars. E. Funds provided by this contract may not be used to pay any expenses of the State Education Department or any of its employees. Terminations A. The State may terminate this Agreement without cause by thirty (30) days prior written notice. In the event of such termination, the parties will adjust the accounts due and the Contractor will undertake no additional expenditures not already required. Upon any such termination, the parties shall endeavor in an orderly manner to wind down activities hereunder. Responsibility Provisions A. General Responsibility Language The Contractor shall at all times during the Contract term remain responsible. The Contractor agrees, if requested by the Commissioner of Education or his or her designee, to present evidence of its continuing legal authority to do business in New York State, integrity, experience, ability, prior performance, and organizational and financial capacity. B. Suspension of Work (for Non-Responsibility) The Commissioner of Education or his or her designee, in his or her sole discretion, reserves the right to suspend any or all activities under this Contract, at any time, when he 51

52 or she discovers information that calls into question the responsibility of the Contractor. In the event of such suspension, the Contractor will be given written notice outlining the particulars of such suspension. Upon issuance of such notice, the Contractor must comply with the terms of the suspension order. Contract activity may resume at such time as the Commissioner of Education or his or her designee issues a written notice authorizing a resumption of performance under the Contract. C. Termination (for Non-Responsibility) Upon written notice to the Contractor, and a reasonable opportunity to be heard with appropriate SED officials or staff, the Contract may be terminated by the Commissioner of Education or his or her designee at the Contractor s expense where the Contractor is determined by the Commissioner of Education or his or her designee to be non-responsible. In such event, the Commissioner or his or her designee may complete the contractual requirements in any manner he or she may deem advisable and pursue available legal or equitable remedies for breach. Safeguards for Services and Confidentiality A. Any copyrightable work produced pursuant to said agreement shall be the sole and exclusive property of the New York State Education Department. The material prepared under the terms of this agreement by the Contractor shall be prepared by the Contractor in a form so that it will be ready for copyright in the name of the New York State Education Department. Should the Contractor use the services of consultants or other organizations or individuals who are not regular employees of the Contractor, the Contractor and such organization or individual shall, prior to the performance of any work pursuant to this agreement, enter into a written agreement, duly executed, which shall set forth the services to be provided by such organization or individual and the consideration therefor. Such agreement shall provide that any copyrightable work produced pursuant to said agreement shall be the sole and exclusive property of the New York State Education Department and that such work shall be prepared in a form ready for copyright by the New York State Education Department. A copy of such agreement shall be provided to the State. B. All reports of research, studies, publications, workshops, announcements, and other activities funded as a result of this proposal will acknowledge the support provided by the State of New York. C. This agreement cannot be modified, amended, or otherwise changed except by a written agreement signed by all parties to this contract. D. No failure to assert any rights or remedies available to the State under this agreement shall be considered a waiver of such right or remedy or any other right or remedy unless such waiver is contained in a writing signed by the party alleged to have waived its right or remedy. E. Expenses for travel, lodging, and subsistence shall be reimbursed in accordance with the policies stipulated in the aforementioned Fiscal guidelines. F. No fees shall be charged by the Contractor for training provided under this agreement. G. Nothing herein shall require the State to adopt the curriculum developed pursuant to this agreement. H. All inquiries, requests, and notifications regarding this agreement shall be directed to the Program Contact or Fiscal Contact shown on the Grant Award included as part of this agreement. 52

53 I. This agreement, including all appendices, is, upon signature of the parties and the approval of the Attorney General and the State Comptroller, a legally enforceable contract. Therefore, a signature on behalf of the Contractor will bind the Contractor to all the terms and conditions stated therein. J. The parties to this agreement intend the foregoing writing to be the final, complete, and exclusive expression of all the terms of their agreement. Iran Divestment Act As a result of the Iran Divestment Act of 2012 (Act), Chapter 1 of the 2012 Laws of New York, a new provision has been added to the State Finance Law (SFL), 165-a, effective April 12, Under the Act, the Commissioner of the Office of General Services (OGS) will be developing a list (prohibited entities list) of persons who are engaged in investment activities in Iran (both are defined terms in the law). Pursuant to SFL 165-a(3)(b), the initial list is expected to be issued no later than 120 days after the Act s effective date, at which time it will be posted on the OGS website. By entering into this Contract, Contractor (or any assignee) certifies that once the prohibited entities list is posted on the OGS website, it will not utilize on such Contract any subcontractor that is identified on the prohibited entities list. Additionally, Contractor agrees that after the list is posted on the OGS website, should it seek to renew or extend the Contract, it will be required to certify at the time the Contract is renewed or extended that it is not included on the prohibited entities list. Contractor also agrees that any proposed Assignee of the Contract will be required to certify that it is not on the prohibited entities list before SED may approve a request for Assignment of Contract During the term of the Contract, should SED receive information that a person is in violation of the abovereferenced certification, SED will offer the person an opportunity to respond. If the person fails to demonstrate that it has ceased its engagement in the investment which is in violation of the Act within 90 days after the determination of such violation, then SED shall take such action as may be appropriate including, but not limited to, imposing sanctions, seeking compliance, recovering damages, or declaring the Contractor in default. SED reserves the right to reject any request for assignment for an entity that appears on the prohibited entities list prior to the award of a contract, and to pursue a responsibility review with respect to any entity that is awarded a contract and appears on the prohibited entities list after contract award. Rev. 6/4/13 53

54 M/WBE Documents M/WBE Goal Calculation Worksheet (This form should reflect Multi-Year Budget Summary totals) RFP # and Title: Applicant Name: The M/WBE participation for this grant is 20% of each applicant s total discretionary non-personal service budget over the entire term of the grant. Discretionary non-personal service budget is defined as the total budget, excluding the sum of funds budgeted for direct personal services (i.e., professional and support staff salaries) and fringe benefits, as well as rent, lease, utilities, and indirect costs, if these are allowable expenditures. Please complete the following table to determine the dollar amount of the M/WBE goal for this grant application. Budget Category 1. Total Budget Amount budgeted for items excluded from M/WBE calculation Totals 2. Professional Salaries 3. Support Staff Salaries 4. Fringe Benefits 5. Indirect Costs 6. Rent/Lease/Utilities 7. Sum of lines 2, 3,4,5, and 6 8. Line 1 minus Line M/WBE Goal percentage (20%) Line 8 multiplied by Line 9 =MWBE goal amount 0.20

55 M/WBE UTILIZATION PLAN INSTRUCTIONS: All bidders/applicants submitting responses to this procurement/project must complete this M/WBE Utilization Plan unless requesting a total waiver and submit it as part of their proposal/application. The plan must contain detailed description of the services to be provided by each Minority and/or Women-Owned Business Enterprise (M/WBE) identified by the bidder/applicant. Bidder/Applicant s Name Telephone/ / Address Federal ID No.: City, State, Zip RFP No.: Certified M/WBE Classification Description of Work Annual Dollar Value of (check all applicable) (Subcontracts/Supplies/Services) Subcontracts/Supplies/Services NAME NYS ESD Certified ADDRESS MBE $ CITY, ST, ZIP WBE PHONE/ FEDERAL ID No. NAME NYS ESD Certified

56 ADDRESS MBE $ CITY, ST, ZIP WBE PHONE/ FEDERAL ID No. PREPARED BY (Signature) DATE SUBMISSION OF THIS FORM CONSTITUTES THE BIDDER/APPLICANT S ACKNOWLEDGEMENT AND AGREEMENT TO COMPLY WITH THE M/WBE REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, ARTICLE 15-1, 5 NYCRR PART 143 AND THE ABOVE REFERENCE SOLICITATION. FAILURE TO SUBMIT COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NONCOMPLIANCE AND/OR PROPOSAL/APPLICATION DISQUALIFICATION. NAME AND TITLE OF PREPARER: (print or type) REVIEWED BY DATE T UTILIZATION PLAN APPROVED YES/NO DATE ELEPHONE/ NOTICE OF DEFICIENCY ISSUED YES/NO DATE DATE NOTICE OF ACCEPTANCE ISSUED YES/NO DATE

57 M/WBE 100 GC#

58 M/WBE SUBCONTRACTORS AND SUPPLIERS NOTICE OF INTENT TO PARTICIPATE INSTRUCTIONS: Part A of this form must be completed and signed by the Bidder/Applicant unless requesting a total waiver. Parts B & C of this form must be completed by MBE and/or WBE subcontractors/suppliers. The Bidder/Applicant must submit a separate M/WBE Notice of Intent to Participate form for each MBE or WBE as part of the proposal/application. Bidder/Applicant Name: Federal ID No.: Address: Phone No.: City State Zip Code Signature of Authorized Representative of Bidder/Applicant s Firm Print or Type Name and Title of Authorized Representative of Bidder/Applicant s Firm Date:

59 PART B GC# - THE UNDERSIGNED INTENDS TO PROVIDE SERVICES OR SUPPLIES IN CONNECTION WITH THE ABOVE PROCUREMENT/APPLICATION: Name of M/WBE: Federal ID No.: Address: Phone No.: City, State, Zip Code BRIEF DESCRIPTION OF SERVICES OR SUPPLIES TO BE PERFORMED BY MBE OR WBE: DESIGNATION: MBE Subcontractor WBE Subcontractor MBE Supplier WBE Supplier PART C - CERTIFICATION STATUS (CHECK ONE): The undersigned is a certified M/WBE by the New York State Division of Minority and Women-Owned Business Development (MWBD). The undersigned has applied to New YorkState s Division of Minority and Women-Owned Business Development (MWBD) for M/WBE certification. THE UNDERSIGNED IS PREPARED TO PROVIDE SERVICES OR SUPPLIES AS DESCRIBED ABOVE AND WILL ENTER INTO A FORMAL AGREEMENT WITH THE BIDDER/APPLICANT CONDITIONED UPON THE BIDDER/APPLICANT S EXECUTION OF A CONTRACT WITH THE NYS EDUCATION DEPARTMENT.

60 The estimated GC# dollar amount of the agreement $ Signature of Authorized Representative of M/WBE Firm Date Printed or Typed Name and Title of Authorized Representative M/WBE 102

61 Total Work Force Male Female White African-American or Black Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Two or More Races Disabled Veteran White African-American Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native Two or More Races Disabled Veteran GC# Applicant Name: Address: City, State, ZIP: EQUAL EMPLOYMENT OPPORTUNITY - STAFFING PLAN (Instructions on Page 2) Telephone: Federal ID No.: Project No: Report includes: Work force to be utilized on this contract OR Applicant s total work force Enter the total number of employees in each classification in each of the EEO-Job Categories identified. Race/Ethnicity - report employees in only one category EEO - Job Categories Hispanic or Latino Male Not-Hispanic or Latino Female Executive/Senior Level Officials and Managers First/Mid-Level Officials and Managers Professionals Technicians Sales Workers

62 Administrative Support Workers Craft Workers Operatives Laborers and Helpers Service Workers TOTAL PREPARED BY (Signature): DATE: NAME AND TITLE OF PREPARER: EEO 100 (print or type) TELEPHONE/ STAFFING PLAN INSTRUCTIONS General Instructions: All Bidders/Applicants in the proposal/application must complete an EEO Staffing Plan (EEO 100) and submit it as part of the package. Where the work force to be utilized in the performance of the State contract/project can be separated out, the Bidder/Applicant shall complete this form only for the anticipated work force to be utilized on the State contract/project. Where the work force to be utilized in the performance of the State contract/project cannot be separated out, the Bidder/Applicant shall complete this form for Bidder/Applicant's total work force. Instructions for Completing: 1. Enter the Project number that this report applies to, along with the name, address, and federal ID number of the Bidder. 2. Check the appropriate box to indicate if the work force being reported is just for the contract/project or the Bidder/Applicant s total work force. 3. Check off the appropriate box to indicate if the Bidder completing the report is the contractor or subcontractor. 4. Enter the total work force by EEO job category. 5. Break down the total work force by gender and race/ethnic background and enter under the heading Race/Ethnicity. Contact the M/WBE

63 Coordinator, if you have any questions. 6. Enter the name, title, phone number and address for the person completing the form. Sign and date the form in designated areas. RACE/ETHNIC IDENTIFICATION For purposes of this form NYSED will accept the definitions of race/ethnic designations used by the federal Equal Employment Opportunity Commission (EEOC), as those definitions are described below or amended hereafter. (Be advised these terms may be defined differently for other purposes under NYS statutory, regulatory, or case law). Race/ethnic designations as used by the EEOC do not denote scientific definitions of anthropological origins. For the purposes of this report, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as belonging. The race/ethnic categories for this survey are: Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races. Disabled -Any person who has a physical or mental impairment that substantially limits one or more major life activity; has a record of such an impairment; or is regarded as having such an impairment Vietnam Era Veteran - a veteran who served at any time between and including January 1, 1963 and May 7, EEO 100

64 M/WBE CONTRACTOR GOOD FAITH EFFORTS CERTIFICATION (FORM 105) PROJECT/CONTRACT # I, (Bidder/Applicant) of (Title) (Company) ( ) (Address) (Telephone Number) do hereby submit the following as evidence of our good faith efforts to retain certified minority- and women-owned business enterprises: (1) Copies of its solicitations of certified minority- and women-owned business enterprises and any responses thereto; (2) If responses to the contractor s solicitations were received, but a certified minority- or woman-owned business enterprise was not selected, the specific reasons that such enterprise was not selected; (3) Copies of any advertisements for participation by certified minority- and women-owned business enterprises timely published in appropriate general circulation, trade and minority- or women-oriented publications, together with the listing(s) and date(s) of the publication of such advertisements; (4) Copies of any solicitations of certified minority- and/or women-owned business enterprises listed in the directory of certified businesses; (5) The dates of attendance at any pre-bid, pre-award, or other meetings, if any, scheduled by the State agency awarding the State contract, with certified minority- and women-owned business enterprises which the State agency determined were capable of performing the State contract scope of work for the purpose of fulfilling the contract participation goals; (6) Information describing the specific steps undertaken to reasonably structure the contract scope of work for the purpose of subcontracting with, or obtaining supplies from, certified minority- and womenowned business enterprises.

65 (7) Describe any other action undertaken by the bidder to document its good faith efforts to retain certified minority - and women- owned business enterprises for this procurement. Submit additional pages as needed. Authorized Representative Signature Date

66 M/WBE CONTRACTOR UNAVAILABLE CERTIFICATION RFP#/PROJECT NAME I, (Authorized Representative) (Title) (Bidder/Applicant s Company) ( (Address) ) (Phone) I certify that the following New York State Certified Minority/Women Business Enterprises were contacted to obtain a quote for work to be performed on the abovementioned project/contract. List of date, name of M/WBE firm, telephone/ address of M/WBEs contacted, type of work requested, estimated budgeted amount for each quote requested. ESTIMATED DATE M/WBE NAME PHONE/ TYPE OF WORK BUDGET REASON 1. 2.

67 To the best of my knowledge and belief, said New York State Certified Minority/Women Business Enterprise contractor(s) was/were not selected, unavailable for work on this project, or unable to provide a quote for the following reasons: Please check appropriate reasons given by each MBE/WBE firm contacted above.) A. Did not have the capability to perform the work B. Contract too small C. Remote location D. Received solicitation notices too late E. Did not want to work with this contractor F. Other (give reason) Authorized Representative Signature Date Print Name

68 REQUEST FOR WAIVER FORM BIDDER/APPLICANT NAME: TELEPHONE: ADDRESS: FEDERAL ID NO.: CITY, STATE, ZIPCODE: RFP#/PROJECT NO.: INSTRUCTIONS: By submitting this form and the required information, the bidder/applicant certifies that Good Faith Efforts have been taken to promote M/WBE participation pursuant to the M/WBE goals set forth under this RFP/Contract.Please see Page 2 for additional requirements and document submission instructions. BIDDER/APPLICANT IS REQUESTING (check all that apply): MBE Waiver - A waiver of the MBE goal for this procurement is requested. Total Partial % WBE Waiver - A waiver of the WBE goal for this procurement is requested. Total Partial % Waiver Pending ESD Certification (check here if subcontractor or supplier is not certified M/WBE, but an application for certification has been filed with Empire State Development) Subcontractor/Supplier Name: Date of application filing: PREPARED BY (Signature): DATE:

69 SUBMISSION OF THIS FORM CONSTITUTES THE BIDDER/APPLICANT'S ACKNOWLEDGEMENT AND AGREEMENT TO COMPLY WITH THE M/WBE REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, ARTICLE 15-A, 5 NYCRR PART 143, AND THE ABOVE REFERENCED SOLICITATION. FAILURE TO SUBMIT COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NONCOMPLIANCE AND/OR PROPOSAL DISQUALIFICATION. NAME OF PREPARER: FOR AUTHORIZED USE ONLY TITLE OF PREPARER: REVIEWED BY: TELEPHONE: DATE: WAIVER GRANTED YES NO TOTAL WAIVER PARTIAL WAIVER ESD CERTIFICATION WAIVER NOTICE OF DEFICIENCY CONDITIONAL WAIVER COMMENTS: _

70 REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONS When completing the Request for Waiver Form, please check all boxes that apply. To be considered, the Request for Waiver Form must be accompanied by documentation for items 1-11, as listed below. If a Waiver Pending ESD Certification is requested, please see Item 11 below. Copies of the following information and all relevant supporting documentation must be submitted along with the request. 1. A statement setting forth your basis for requesting a partial or total waiver. 2. The names of general circulation, trade association, and M/WBE-oriented publications in which you solicited certified M/WBEs for the purposes of complying with your participation goals. 3. A list identifying the date(s) that all solicitations for certified M/WBE participation were published in any of the above publications. 4. A list of all certified M/WBEs appearing in the NYS Directory of Certified Firms that were solicited for purposes of complying with your certified M/WBE participation levels. 5. Copies of notices, dates of contact, letters, and other correspondence as proof that solicitations were made in writing and copies of such solicitations, or a sample copy of the solicitation if an identical solicitation was made to all certified M/WBEs. 6. Provide copies of responses made by certified M/WBEs to your solicitations. 7. Provide a description of any contract documents, plans, or specifications made available to certified M/WBEs for purposes of soliciting their bids and the date and manner in which these documents were made available. 8. Provide documentation of any negotiations between you, the Bidder/Contractor, and the M/WBEs undertaken for purposes of complying with the certified M/WBE participations goals. 70

71 9. Provide any other information you deem relevant which may help us in evaluating your request for a waiver. 10. Provide the name, title, address, telephone number and address of the Bidder/Contractor's representative authorized to discuss and negotiate this waiver request. 11. Copy of notice of application receipt issued by Empire State Development (ESD). NOTE: Unless a Total Waiver has been granted, Bidder/Contractor will be required to submit all reports and documents pursuant to the provisions set forth in the procurement and/or contract, as deemed appropriate by NYSED, to determine M/WBE compliance. 71